[New autoanti-bodies in rheumatoid arthritis: anti-citrullinated protein or peptide autoanti-bodies and the others].
New treatment strategies require that rheumatoid arthritis (RA) be diagnosed as early as possible. New diagnostic markers were required, because rheumatoid factors (RF), until now criteria for classification of RA, are not sufficiently specific and sometimes appear late, thereby limiting their diagnostic usefulness. The objective of this review is to describe the current state of knowledge and more particularly to analyze the interest of new RA autoanti-bodies, called anti-peptide or anti-citrullinated protein anti-bodies (ACPA). Other autoanti-bodies have been described, including anti-Sa, anti-alpha enolase, and anti-calpastatin autoanti-bodies. Nonetheless, their diagnostic value remains limited compared to ACPA. Accordingly, in daily practice today, the only autoanti-bodies that must be tested for to diagnose RA are the ACPAs and RFs. The discovery of ACPA (initially called anti-keratin and anti-perinuclear anti-bodies) was a major step forward for the laboratory diagnosis of RA. The tests most often used routinely areenzyme-linked immunosorbent assays(ELISA) with cyclic citrullinated peptides, whence the name anti-CCP autoanti-bodies. Accordingly, the two terms ACPA and anti-CCP can both be used. The diagnostic value, in particular their specificity, is on the order of 95%, regardless of the method of identification. These markers are very useful and are often present earlier than RF. These ACPA also have prognostic value because they are associated with more aggressive forms of RA. On the other hand, their value over time, in particular, their fluctuation as a function of treatment, is more controversial. In practice, it is recommended to test for both RF and ACPA in a diagnostic work-up for early RA. During follow-up, the value of testing for these autoanti-bodies has not been demonstrated, but additional studies are still necessary with the anti-CCP autoanti-bodies and the new anti-citrullinated protein autoanti-bodies.
Fabien
Nicole
N
Laboratoire d'auto-immunité, Hospices Civils de Lyon, Centre hospitalier Lyon-Sud, F-69495 Pierre Bénite Cedex, France.
Goetz
Joëlle
J
Sordet
Christelle
C
Humbel
René-Louis
RL
Sibilia
Jean
J
D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000276:immunology*; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology*; D002956:Citrulline / Q000276:immunology*; D023281:Genomics; D006801:Humans; D010455:Peptides / Q000276:immunology*; D040901:Proteomics; D012680:Sensitivity and Specificity
D001323:Autoantibodies; D010455:Peptides; D002956:Citrulline